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SUPPLEMENT_tD Web App ZONING PERMIT APPLICATION www.countyofdane.coi <br /> :PROPERTY voiER INFORMATicir �`. ,.' CUSTOMER TO PROVIDE <br /> OWNER NAME // <br /> I✓1/L ilitteZ b'►(e r ❑Zoning Status; CUP; <br /> OWNER ADDRE (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /l h D(AAk' /.1C : Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0— " icj Cbh ❑Site Plan drawn to scale <br /> AGENT INFO RMATION _ CONTRACTOR_INFORMATION.•s.a,;,y `, and includes dimensions <br /> AGENT NAME CT��R NAIME / <br /> CO�r'`'r dr1571rG4CXVA. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR A DRESS of well/septic <br /> ,p i, I (dc, . <br /> (City,State,Zip) (City, at ,Zip) ❑Setbacks <br /> A/er Z/t 06- <br /> PHONE PHO6-0b--d E/ ❑Site Plan approval from - <br /> 1/471 -AD I ( applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> a,/ 4 bie,,d€. i . >f -c ore ❑Floor plans to scale <br /> :PROPERTY/LOCATION INFORM ATION ;(hittpe//accessdane cO;da_ ne;Wi usn , ; < Li Elevation of property <br /> PARENT PARCEL NUMBER: CU- ENT ZONING: ACREA <br /> ❑PARCEL / / _E r I. frontage drawn to scale. <br /> NUMBER r � '�� � tom, __r <br /> TOWNSHIP: SECTION: 1 <br /> 1') Ai, k �4: /,/4. ❑Driveway permits <br /> ADDRESS! _ (state,county,town) <br /> l/al7 ✓gAe kirk 4/4 u*f1Ale.,,,, RV 1 fl Sanitary permits <br /> CSM: LOT SUBDIVISIO -BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF;REVIEW <br /> PROJECT DESCRIPTI eiC e ���e C_ t 0 , <br /> Zornng Dist ract rk <br /> • This project is a new building or structure. 0 Permitfed Use? <br /> ❑This project is an addition/alteration to an existing building or structure. 3 r, , t 4, <br /> r x_ <br /> SANITARY SERVICE: PERMIT NUMBER: ® RUralAddfeSSA. r <br /> EWER REPTIC (neW/e acting) _ _ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ❑ - <br /> ' . <br /> d _ Wetland/Floodplam/ _ <br /> Shoreland(a-ttachment) <br /> AREA TO NEAREST SQUARE FOOT + ., r4 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) `® f " <br /> BASEMENT: 1ST FLO EfOSIOn Onr01 pP,frlllt <br /> 4, TOTAL SQUARE FOOTAGE 1 slopes tilsturbance <br /> /v� ,, '.v "�-#sue ,.. • :t <br /> fa filflrtaccess) � ; <br /> 2ND FLOOR: 3RD FLOOR: - -,,a �r�,f-C31 3 <br /> rya /, 9016 x Review at o Survey <br /> ESTIMATED CONSTRUCTION COST: d' 4'�and available optlonsY <br /> -► -► -► -► -► -t► $ A. <br /> (Please round to nearest dollar) , V •p O 3X t _; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? KYes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 10Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - g]Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [ 'es ❑Ilo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Vo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -4 <br /> 545-112(4/08) <br />